In a rare show of bipartisanship for the mostly polarized 115th Congress, the Bipartisan Budget Act of 2018 is officially one for the record books. The week leading up to the final vote was far from smooth with Sen. Nancy Pelosi impressively filibustering on the floor of the U.S. Senate for eight hours to Rep. Rand Paul blocking the final vote late Thursday night/early Friday morning and forcing a six-hour government shutdown before allowing the final vote to be taken.

Now that President Trump has signed the Bipartisan Budget Act of 2018 here’s what you need to know:

Technical Amendments to MACRA. Makes several changes to the Medicare Access and CHIP Reauthorization Act (MACRA) that the medical community has been strongly advocating for, including:

Excludes Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination;

Eliminates improvement scoring for the cost performance category for the third, fourth and fifth years of MIPS;

Allows CMS to reweight the cost performance category to not less than 10 percent for the third, fourth, and fifth years of MIPS;

Requires CMS to update on CMS’ website by Dec. 31 of each year, information on resource use measures including measures under development, the time-frame for such development, potential future resource use measure topics, a description of stakeholder engagement and the percent of expenditures under Medicare Part A and B that are covered by resource use measures.

Allows CMS flexibility in setting the performance threshold for years three through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year;

Allows the Physician Focused Payment Model Technical Advisory Committee (PTAC) to provide initial feedback regarding the extent to which models meet criteria and an explanation of the basis for the feedback.

Physician fee schedule update (in lieu of Misvalued Codes). Reduces the Physician Fee Schedule conversion factor for 2019 from 0.5 percent to 0.25 percent. This is more favorable language than, and is in lieu of, the language in the House bill that would extend the “misvalued codes” provision for one additional year. The AMA estimated, based on the recommendations of the AMA / Specialty Society Relative Value Scale Update Committee (RUC), that the misvalued code provision in the House bill would have reduced the statutory 0.5 percent payment update in 2019 by 0.45 percent. Rejection of the misvalued code policy is an important outcome for future budget saving exercises. On a bipartisan basis, policymakers have recognized that the misvalued code “budget dial” is tapped out and should be shelved.

IPAB. Permanently repeals the Independent Payment Advisory Board. IPAB was a 15-member government agency created in 2010 by the Affordable Care Act for achieving specified savings in Medicare without affecting coverage or quality.

Children’s Health Insurance Program (CHIP). CHIP is extended for an additional four years beyond the previous Continuing Resolution’s six-year extension, with appropriations made through 2027.

Community Health Centers. Funding for community health centers is reauthorized for two years at a level of $3.8 billion for FY 2018 and $4 billion for FY 2019.

National Health Service Corps. Funding for the National Health Service Corps is extended at the FY 2015 – 2017 annual level of $310 million for two additional years.

Teaching Health Center Graduate Medical Education. Funding for Teaching Health Center Graduate Medical Education is extended for two years at an annual level of $126.5 million, more than doubling annual funding for this program.

Geographic Practice Cost Indices (GPCI) floor. Extends the work GPCI floor for two additional years through Jan. 1, 2020.

Reducing EHR Significant Hardship. Removes the current mandate that meaningful use standards become more stringent over time. This eases the burden on physicians as they would no longer have to submit and receive a hardship exception from HHS.

Closing the Donut Hole for Seniors. Closes the Medicare Part D prescription drug “donut hole” sooner than under current law by increasing the discounted price manufacturers provide from 50 percent to 70 percent.

Emergency Medicaid Funds for Puerto Rico and the U.S. Virgin Islands. Puerto Rico’s Medicaid caps for 2018 – 2019 are increased by an additional $4.8 billion. The Virgin Islands’ caps are increased over the same time period by $142.5 million. Also, 100 percent federal cost sharing for Medicaid is provided for both territories through Sept. 30, 2019.

Prevention and Public Health Fund (PPHF). The Senate bill reduces funding for the PPHF by $1.35 billion between FY 2018 – 2027.

Other Select Budget Agreement Provisions:

Note: there is an agreement to include these funds in the Omnibus before the March 23 deadline.

From President Trump’s new tax plan to renewed funding for the Children’s Health Insurance Program to former President Obama’s Independent Payment Advisory Board, health care has been at the center of a lot of discussions this week on Capitol Hill.

Vote Expected Today for CHIP — The House is expected to vote today to pass legislation to refund Children’s Health Insurance Program and send federal funds to community health centers. However, questions remain about how to pay for the funding efforts. The original funding legislation for CHIP expired a month ago leaving state programs scrambling to extending their budgets to cover millions of covered children. It’s expected that the bill will face party opposition in the Senate. While both parties have agreed to renew CHIP, how to pay for the program remains the sticking point.

New Tax Plan Proposed — The proposal repeals the student loan interest deduction — a policy that helped more than 12 million students with education loans save up to $2,500 on their tax bills in 2015. Taxpayers aren’t required to itemize their deductions to claim it, but it’s available to anyone paying interest on either private or public student loans and makes less than $80,000 in a year. Many of those student loan holders are recent medical school graduates, who make a median $54,600 in their first year of residency, according to the Association of American Medical Colleges.

No More IPAB? — The House voted Thursday to abolish the Independent Payment Advisory Board (IPAB), a federal panel that was intended to find ways to curb Medicare spending with little Congressional oversight. It was a creation of the ACA, yet the IPAB’s presidentially-appointed members were never named. The bill now moves to the Senate where Republicans may have difficulty finding the necessary votes to pass it as a stand-alone bill before the end of the year.